EP3288495B1 - Dispositif à débit réduit de stimulateur cardiaque lors d'un remplacement de valvules cardiaques - Google Patents

Dispositif à débit réduit de stimulateur cardiaque lors d'un remplacement de valvules cardiaques Download PDF

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Publication number
EP3288495B1
EP3288495B1 EP16719802.7A EP16719802A EP3288495B1 EP 3288495 B1 EP3288495 B1 EP 3288495B1 EP 16719802 A EP16719802 A EP 16719802A EP 3288495 B1 EP3288495 B1 EP 3288495B1
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EP
European Patent Office
Prior art keywords
prosthesis
locator
proximal
prosthesis according
stent
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EP16719802.7A
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German (de)
English (en)
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EP3288495A1 (fr
Inventor
Stefan Schreck
Hussain S. Rangwala
Payam SAFFARI
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Jenavalve Technology Inc
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Jenavalve Technology Inc
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Priority to EP19195062.5A priority Critical patent/EP3632378B1/fr
Publication of EP3288495A1 publication Critical patent/EP3288495A1/fr
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
    • A61F2/2412—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body with soft flexible valve members, e.g. tissue valves shaped like natural valves
    • A61F2/2418—Scaffolds therefor, e.g. support stents
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61L—METHODS OR APPARATUS FOR STERILISING MATERIALS OR OBJECTS IN GENERAL; DISINFECTION, STERILISATION OR DEODORISATION OF AIR; CHEMICAL ASPECTS OF BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES; MATERIALS FOR BANDAGES, DRESSINGS, ABSORBENT PADS OR SURGICAL ARTICLES
    • A61L31/00—Materials for other surgical articles, e.g. stents, stent-grafts, shunts, surgical drapes, guide wires, materials for adhesion prevention, occluding devices, surgical gloves, tissue fixation devices
    • A61L31/14—Materials characterised by their function or physical properties, e.g. injectable or lubricating compositions, shape-memory materials, surface modified materials
    • A61L31/18—Materials at least partially X-ray or laser opaque
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2210/0014—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0004—Rounded shapes, e.g. with rounded corners
    • A61F2230/0013—Horseshoe-shaped, e.g. crescent-shaped, C-shaped, U-shaped
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0028—Shapes in the form of latin or greek characters
    • A61F2230/0054—V-shaped
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0028—Shapes in the form of latin or greek characters
    • A61F2230/0056—W-shaped, e.g. M-shaped, sigma-shaped
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2230/00—Geometry of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2230/0002—Two-dimensional shapes, e.g. cross-sections
    • A61F2230/0028—Shapes in the form of latin or greek characters
    • A61F2230/006—Y-shaped
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0014—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis
    • A61F2250/0032—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof having different values of a given property or geometrical feature, e.g. mechanical property or material property, at different locations within the same prosthesis differing in radiographic density
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/0096—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
    • A61F2250/0097—Visible markings, e.g. indicia
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2250/00—Special features of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2250/0058—Additional features; Implant or prostheses properties not otherwise provided for
    • A61F2250/0096—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers
    • A61F2250/0098—Markers and sensors for detecting a position or changes of a position of an implant, e.g. RF sensors, ultrasound markers radio-opaque, e.g. radio-opaque markers

Definitions

  • the present disclosure relates to heart valve prostheses with reduced pace maker rate and means and methods for visualization of the correct implantation of a medical device at the target site in a patient.
  • a number of applications have been established making use of medical devices, which can be delivered by way of minimally invasive methods in a patient.
  • An example of such a medical device is a heart valve prosthesis.
  • a particular example is a catheter-based aortic valve prosthesis consisting of a self-expanding stent and a valve known for treating aortic insufficiency.
  • Such heart valve prostheses are positioned at the aortic annulus to replace the endogenous aortic valve. The aim is to correctly position the heart valve prosthesis with regard to the aortic annulus and the endogenous cusps.
  • WO2004/019825 describes an aortic prosthesis wherein the prosthesis exhibits feelers which are meant to be deployed first and placed into the aortic cusps. Once the feelers have been placed within the cusps the stent is deployed to complete the implantation. The entire implant procedure is guided by fluoroscopic imaging. The stent and feelers are visible under fluoroscopy. The aorta, aortic valve, and left ventricle are visualized indirectly by injecting contrast medium through an angiographic catheter into the left ventricle and ascending aorta. During valve deployment the angiographic catheters are retracted to avoid interference between the stent and the angiographic catheter. Thus, the operator mainly relies on tactile feedback for feeler placement.
  • the tactile feedback may be inconsistent due to the tortuosity of the access vessels and the curvature of the aortic arch.
  • the prosthesis may not be placed sufficiently correct at its target site.
  • feelers, cusp positioners, hooks, rims or similar means to provide for precise positioning and/or targeting the endogenous leaflet cusps, these means may not be correctly positioned and/or they may be placed away from the base of the cusps or may damage the cusps.
  • Another issue is leakage of blood between the replacement heart valve and the endogenous tissue e.g. at the annular ring of the aortic heart valve.
  • Known prostheses try to improve leak tightness by applying or forming a ring or band along the annular ring and cover the prosthesis by a symmetric band made of biological or synthetic tissue.
  • Some disclosures try to improve the leak tightness with the combination of the outward force of the prosthesis and the symmetrical band aligned along the annular ring. This approach is commonly used and it is acknowledged that a symmetrical sealing ring is a useful approach, which serves the purpose, however, this approach is not always 100% successful.
  • pacemaker implantation after heart valve replacement therapy Yet another issue is the need for pacemaker implantation after heart valve replacement therapy.
  • therapies and heart valve prostheses a considerable number of patients require a pacemaker implantation after heart valve replacement therapy.
  • the percentages of the requirement for pacemaker transplantation vary between these products. It is acknowledged that the pacemaker requirement is unwanted and makes yet another surgery necessary including all its negative implications.
  • US2010082094 A1 discloses a heart valve including a valve body made of a flexible material such as pericardium.
  • the valve body is made of two layers of material, an outer layer, and an inner layer that defines a plurality of leaflets.
  • the leaflets of the inner layer are attached to the outer layer.
  • the valve body is made by cutting a single piece of flat source tissue, folding the cut tissue and forming it into a tubular pattern having the inner and outer layers.
  • the multi-layer valve body can be mounted on a stent for delivery within a patient's heart.
  • invention and or “embodiment” are used in the following, and/or features are presented as being optional, this should be interpreted in such a way that the only protection sought is that of the invention as claimed. It is another object to provide for a means for safely positioning replacement heart valves into an individual's body at a target site. Any method disclosed herein which includes at least one surgical or diagnostic step does not form part of the invention.
  • replacement heart valve prostheses with the reduced need of pacemakers.
  • the reduced need for pacemaker application after the replacement heart valve implantation may be related to aspects of the prosthesis design.
  • a catheter device in a transfemoral or transapical manner.
  • the catheter may be adapted to the prosthesis in order to allow easy and correct implantation into the heart of an individual.
  • a method for the visualization of the positioning of a medical implant exhibiting deformable detector means at an implant site inside a patient body wherein i. the implant is delivered by appropriate means close to or at least relatively close to the target implantation site; ii. the implant is approached to its final target site; iii. the approach of the implant is stopped when the deformable detector means indicate contact with the tissue of the final target site.
  • Heart valve prosthesis or “prosthesis” or “medical implant” or “medical device” in the sense of the disclosure is any medical device like a heart valve that may be implanted into a patient by means of a minimally invasive procedure e.g. by way of the use of a catheter or a similar delivery device.
  • Prosthesis relates to aortic, mitral and tricuspid replacement heart valves.
  • proximal refers to the part of the prosthesis which will be closer to the apex of the heart during or when implanted
  • distal refers to the part of the prosthesis which is further away from the apex of the heart during or when implanted.
  • proximal may also be used in the context of the locator means.
  • varying in connection with the proximal end or the edge of the proximal end refers to the specific design of the disclosed subject matter, wherein the edge of the proximal end of the prosthesis can be uniform and describe a ring ending at the same level.
  • different sections of the prosthesis can be designed in a way so as to have their edges of the proximal ends at differing levels and thus represent differing distances to e.g. the locator means in case the prosthesis consists of three sections wherein each section comprises on locator means.
  • the proximal end of the prosthesis may exhibit an undulating proximal edge.
  • Tube perimeter refers to e.g. a nitinol tube which is laser cut in order to receive the stent component of the prosthesis and which describes the same inner and outer dimension and surface over the tube. Accordingly, in some embodiments, no parts of the cut stent may substantially stick inwardly or outwardly of said tube.
  • the term “foreshortening” describes the change of position or position of the proximal end of the locator means when the stent component is expanded and the proximal end of the locator means moves outwardly of the tube perimeter and towards the proximal end of the prosthesis.
  • the distance between the proximal end of the locator means and the proximal end of the stent may be reduced “shortened” as compared to the non-expanded position of the proximal end of the locator means.
  • the “foreshortening” may depend on the design of the locator means as such and on the connection with other parts of the stent.
  • a design such as an arch may be advantageous and its connections with its ends at each side with a fastening arch of the stent.
  • the "foreshortening” can be defined and it can vary between 1 and 15 mm, or one can achieve a foreshortening of 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, or 15 mm.
  • a "fastening arch” is a part of the stent to which the valve component is fixed, e.g., by suitable means and methods.
  • a “non-expanded state” and “expanded state” of the prosthesis refers to a design wherein the prosthesis can be crimped and placed to or in a catheter for minimally invasive delivery purposes.
  • the prosthesis may be expanded by balloon expansion or self-expandable, and when placed and positioned at its target site it may exhibit its "expanded state".
  • the "non-expanded state” represents the minimal diameter of the prosthesis and the “expanded state” represents its biggest diameter.
  • the prosthesis when positioned at its target site may exhibit outward forces against e.g. the annular ring which may exhibit a force in counter direction and thus the prosthesis may not exhibit in this state its maximal diameter. The outward force may contribute to the fixation/positioning of the prosthesis.
  • Heart pacemaker or “pacemaker” in the sense of the disclosure are devices to trigger and control an appropriate or normal heart rate in an individual.
  • Pacemaker rate or the “need for pacemaker” or “the need for pacemaker implantation” relates to the fact that in heart valve replacement therapy after implantation of the prosthesis a number of patients require pacemakers. Accordingly, an additional surgery is required in such individuals.
  • Pacemaker rate in this context refers to the percentage of individuals who need a pacemaker after valve implant .
  • the pacemaker rate in currently available replacement heart valve treatment is in the range of 10 % to 30 %.
  • Indicator means or “indicators” in the sense of the disclosure are any constructive means that allow or facilitate the easy and precise positioning, e.g., by way of a visualization apparatus or devices that allow controlling the position of the medical device within a patient.
  • Locator means or “locator” or “feeler” in the sense of the disclosure is to be understood as any constructive element as part of the medical device to be implanted in an individual and which allows or facilitates the implantation and positioning, e.g., by making contact with or within a body or tissue part of the individual.
  • the locator may be designed as is appropriate under the circumstances which will be described in more detail below.
  • Locator probe may form part of or be used together with a locator means and it may facilitate the correct positioning of the prosthesis at the target site in the individual. For easier visualization a opaque marker may be used.
  • valve component in the sense of the disclosure is a biological or synthetic valve placed within the stent component and which may replace the endogenous valve function. It may comprise additional components to optimize the valve and overall prosthesis function, including, by not limited to, internal and/or external covers of the same or different biological and/or synthetic materials and sealing means.
  • a “sealing means” in the sense of the disclosure is a particular tissue, lining, covering, band made of synthetic and/or biological material that may be positioned outside the stent component, e.g., which may serve the purpose to prevent reflux of blood when the valve is in its closed position. In some embodiments, it is designed as a band around the stent component in e.g. an aortic valve as a symmetrical band at the location of the annular ring and which represents a sealing between the prosthesis and the endogenous valve.
  • the "sealing means" of the disclosed prosthesis may be symmetrical and/or non-symmetrical and it may follow in particular at the outside of the prosthesis and may represent a covering. In a non-symmetrical design of the prosthesis as disclosed the "sealing means" may be more distal in the NCS section and more distal in the other two sections (16) (18).
  • target site in the sense of the disclosure is the endogenous heart valve to be replaced by the replacement heart valve.
  • target site is the position where the replacement heart valve will be implanted.
  • Shortest distance in the sense of the disclosure refers to two points that relate to design features of the prosthesis like locator and distal end which can be compared to the distance of other design features wherein the distance is measured in the same manner.
  • Opaque marker in the sense of the disclosure is to be understood as any material that can be visualized by an apparatus to visualize the position of the device outside the individual's body during surgery or thereafter.
  • Visualization or “to visualize” in the sense of the disclosure includes any way to project the opaque marker and thus prosthesis position outside the individual's body.
  • the disclosure relates to an aortic heart valve prosthesis for reducing the need for pacemaker implantation.
  • Figure 1 illustrates the anatomical location of the bundle of His of the conductive system. The bundle of His is located at the septum approximately 2mm-10mm below the aortic annulus and the non-coronary sinus.
  • Many transcatheter prostheses for aortic valve replacement include a balloon or self-expanded stent scaffold that anchors the prosthesis in the aortic annulus. There is evidence that the stent scaffold interferes with the conductive system of the heart, which may result in the need for pacemaker implantation.
  • a stent scaffold that extends into the left ventricle or excessively stretches the tissue in the aortic annulus may injure or irritate the bundle of His.
  • the stent scaffold of the valve prosthesis includes axially extending locators.
  • the locators may be positioned within the cusp of the native aortic valve. Placement of the locators within the cusps may prevent further proximal movement of the stent scaffold into the left ventricle.
  • the distance from the proximal end of the locators to the proximal end of the stent scaffold may be less than 10mm, for example between 1mm-5mm.
  • the location of the proximal end of the locators with respect to the proximal stent scaffold may require the locators to overlap with the proximal stent ring of the stent scaffold.
  • the locators and the stent scaffold of the prosthesis are cut from the same metal tubing. This may minimize the profile of the prosthesis.
  • Figure xx demonstrates an embodiment of an one-piece stent scaffold with locators.
  • the locators may be connected to the midsection of the stent by diagonal struts. Expansion of the stent scaffold from the crimped configuration into the implant configuration may cause foreshortening of the diagonal struts and proximal movement of the proximal end of the locators.
  • the proximal end of the locators may not overlap with the most proximal stent scaffold ring.
  • the stent scaffold may have a low profile for placement in the delivery system.
  • the proximal end of the locators may overlap with the most proximal stent scaffold ring.
  • the proximal end of the locators is located less than 10mm, e.g., between 1mm and 5mm, away from the proximal end of the stent scaffold when the stent scaffold is fully expanded.
  • interference of the stent scaffold with the bundle of His may be mitigated by an asymmetric stent scaffold design.
  • the most proximal segment of the stent scaffold along the non-coronary sinus may be moved distally with respect to the most proximal segments of the stent scaffold along the left and right coronary sinus.
  • the most proximal segment of the stent scaffold along the coronary sinus may be within or supra to the aortic annulus.
  • the para-valvular seal zone in the non-coronary segment of the prosthesis may extend into the non-coronary sinus.
  • Distal extension of the seal zone may be possible since the non-coronary sinus is void of coronary arteries that need to be kept patent to perfuse the heart.
  • an asymmetric design of the prosthesis may take advantage of the unique anatomical location of the bundle of His with respect to the annulus and the non-coronary sinus.
  • the seal elements of the prosthesis may be located proximal to the coronary arteries in the left and right coronary sinus and distal to the coronary arteries in the non-coronary sinus.
  • the prosthesis may have an asymmetric design and two locators for placement in the right and left coronary cusps.
  • the non-coronary segment of the stent scaffold may not have a locator but a supra-annular stent segment that contacts the wall of the non-coronary sinus.
  • the disclosure relates to a heart valve prosthesis for reducing the need for pacemaker after positioning at a target site, comprising a stent component, a valve component, a sealing means, and at least one locator means for a defined positioning of the prosthesis at the target site of an endogenous heart valve, and wherein the prosthesis may be expandable from a non-expanded to an expanded state, and wherein in the expanded state a shortest distance between a proximal end of the locator means and a proximal end of the prosthesis may be less than 15mm, such as less than 10, 8, or 5mm.
  • the prosthesis as disclosed herein may exhibit a number of advantages compared to other devices at least partially due to its engineering.
  • one advantage may be that the design of the prosthesis makes sure that the coronary arteries are substantially not covered or blinded by any prosthesis section or area and thus the circulation of blood is not affected.
  • Another advantage of the prosthesis as disclosed may be that its implantation may not substantially interfere with the heart functions. For example, its implantation may result in low side effects, e.g., such that the rate of pacemakers needed may be comparably low as compared to other devices.
  • the heart valve prosthesis as disclosed comprises a locator means comprising a locator probe for the visualization of the locator means.
  • the prosthesis can be a tube and/or mesh like design with symmetrical end portions. It can as well have in its structure within the tube structure asymmetrical with meander like structures and it can as well be designed so that the distance between a proximal end of the locator means in case there are two or three locator means referring to the three sections as described herein and a proximal end of the prosthesis is varying in circumferential direction. The same is possible for the distal end of the prosthesis. Such a design may be suitable, for example, wherein the proximal and/or distal end is varying in its end dimensions.
  • Such a design may provide an advantage wherein critical areas and/or various other areas of the heart may be kept without contact with the prosthesis, or the contact may be minimal or such areas of the heart even repeatedly with or without contact with the prosthesis.
  • the disclosure may allow for the respective functional areas of the heart to exhibit without interference its functions. Examples may include the coronary arteries and the bundle of His.
  • the prosthesis as disclosed herein in one aspect may be designed wherein in the non-expanded state the locator means and the stent component extend along a tube perimeter and in the expanded state the locator means extend at least partially outside an expanded tube perimeter.
  • locator means in one aspect may be characterized in that in the expanded state the locator means is positioned in proximal direction at least partially over the remaining stent portion (e.g., foreshortening).
  • the foreshortening may allow for a design - possibly in combination with one or more other dimensions of the prosthesis - which finally allows for a precise and correct positioning of the prosthesis at the target site and may reduce - possibly together with one or more other design features of the prosthesis as disclosed herein - the need for pacemaker implantation.
  • the foreshortening of the locator means in the expanded state compared to the non-expanded state is 1, 2, 3, 4, or 5 mm.
  • the foreshortening can be adapted in particular prosthesis seizes, e.g. 23, 25 or 27 French, as may be useful in connection with the other prosthesis design features and seizes and dimensions. In such a manner the positive effect of reduced pacemaker need may be optimized as will be appreciated by the skilled person.
  • the locator means is made as a locator arch and is attached to or forming an integral part of the stent component.
  • the prosthesis may contain three locator means, each one being positioned in one section of the prosthesis. It may as well be designed in other geometrical forms.
  • the locator arch is attached or forming an integral part with each of its ends with one fastening arch of the prosthesis.
  • at least two fastening arches e.g., six fastening arches, two in each of the three prosthesis sections and three locator means respectively, may separate from each other and the locator arch may move with its tip in direction to the proximal end of the prosthesis.
  • the positioning of the prosthesis and the dimensions of cusp positioning of the locator means may be one, two or three, and the proximal end within the target site (i.e. the endogenous heart valve) may be defined as well as the distances between the locator means ends as well as the proximal end of the prosthesis.
  • the fastening arch comprises fastening means which may serve for adjusting the valve component on the stent component.
  • fastening means which may serve for adjusting the valve component on the stent component.
  • Other components like covers inside and/or outside the stent component made from biological or synthetic materials may also form part of the prosthesis as desired. Such covers may serve as sealing means.
  • the prosthesis as described herein is designed in a manner to substantially not cover the coronary arteries in the expanded state when placed at the target site.
  • the stent and covering components may be designed so that the respective parts are not at all covered, or exhibit one or more indentations provide for no or less or repeatedly no contact in line with the repeating heart beat of the individual.
  • the respective functional areas of the heart may perform their functions without that the implanted prosthesis interferes therewith.
  • the prosthesis as disclosed herein is exhibiting or can be structured in three sections and wherein one section corresponds to the right coronary sinus (RCS), a second section corresponds to the left coronary sinus (LCS) and a third section corresponds to the non-coronary coronary sinus (NCS).
  • the prosthesis as disclosed herein can further exhibit in one embodiment the sections wherein the three sections each comprise a distal and a proximal end, and said proximal ends extend with an equal length so that the sections RCS, LCS, NCS end at the same level, or the proximal ends corresponding to the RCS and LCS sections are shorter than the NCS section.
  • the end of the prosthesis in combination with the dimensions as chosen for the locator means lead to a proximal end of the prosthesis that enters the left ventricle beyond the annular ring with less than 10mm, such as less than 5mm.
  • the design of the disclosed prosthesis may provide that the heart functions are not or only minimally interfered with.
  • the prosthesis may exhibit a shortened NCS section at the proximal end and thus may avoid contact with the bundle of His.
  • the prosthesis as disclosed herein may be characterized in that the three proximal sections extend with an equal length so that the sections RCS, LCS, NCS end at the same level within the left ventricle and at the same time the NCS proximal section comprises an indentation.
  • the indentation may provide also a design feature that avoids interference of the prosthesis with the endogenous heart functions such as inter alia a regulated and repeated heart beat.
  • all three alternative designs of the prosthesis as disclosed herein may provide for a heart valve replacement therapy with less interference of the implanted prosthesis with the endogenous heart functions and may provide for inter alia a reduced need of pacemaker implantation.
  • the prosthesis as disclosed herein may achieve positive and advantageous pacemaker rates, e.g., depending on the particular design features.
  • the prosthesis as disclosed herein after implantation in an individual may thus achieve positive pacemaker rates and may induce the need for pacemaker implantation of less than 15 %, such as less than 10 %, e.g., less than 8 %.
  • that the present disclosure includes a replacement heart valve prosthesis design wherein the proximal end of the proximal three sections has a shorter section NCS (17) (thus having a non-symmetrical overall design) and a non-symmetrical sealing means, which performs a good valve function and at the same time exhibits a sufficiently good sealing function and provides for a reduced need of pacemaker implantation.
  • the sealing means may have a wave-like or U- or inverted V-shape and the sealing function may be achieved in the sections 16 and 18 at a more proximal and in the section 17 at a more distal area of the prosthesis.
  • the areas which connect or lay between the actual sections 16, 17, 18 may be sufficient to provide for a sufficient and good sealing function.
  • sealing means and sealing function may be equally designed and achieved as described above in the exemplary embodiment with an indentation area as described herein.
  • the prosthesis as disclosed may comprise a means for visualizing the positioning of the prosthesis at a target site of an individual wherein the means consists of or comprises a deformable indicator means.
  • the indicator means may be adapted to the other components of the prosthesis and can be adapted in any manner so that it can exhibit its function.
  • the indicator means may comprise or consist of one or more wires or antennas.
  • the indicator means may comprise radiopaque material.
  • the prosthesis as described herein may comprise a counterpart to the indicator means suitable to contact each other.
  • This counterpart may be designed in any suitable manner, and wherein the counterpart may be a locator means, a feeler, a cusp positioner, a hook and/or a rim, such as wherein the locator means, feeler, cusp positioner, hook and/or rim has U, V, Y, M or W shape.
  • the prosthesis as described herein may be characterized in that the indicator means and the locator means, feeler, cusp positioner, hook and/or rim may comprise the same or different materials. In one embodiment also the counterpart may comprise radiopaque material.
  • a feeler means or the like may form part of the prosthesis.
  • the indicator means and the feeler means or the like for a visualization means both may produce a visualizable signal. Accordingly, the operator may recognize the two signals produced by the indicator and feeler means, e.g., when the prosthesis has not reached the appropriate position.
  • the feeler(s) e.g., three feelers
  • the contact of the indicator means with the cusp bottom may effect a change of the geometry of the indicator means and the indicator means and the feelers may be in close proximity or in contact with each other so that the two visual signals may unify to produce at least partially at the indicator and feeler means one single signal.
  • the feeler(s), e.g., the three feelers, and indicator means may be located in the cusps of the endogenous valve cusps and may produce three instead of six visual signals readily visible by the operator by way of suitable visualization means. Accordingly, the prosthesis may be positioned and its positioning can be controlled easily and efficiently.
  • the prosthesis as described may comprise and be made of various materials suitable for heart valve prostheses, which may consist of or comprise nitinol, soft fabric, textile, mammalian tissue, or one or more polymers, such as silicone, polyurethane, or ePTFE.
  • the prosthesis as described herein may be capable of replacement of any endogenous heart valve.
  • it may be useful for the replacement therapy of an aortic, or mitral heart valve.
  • the disclosure relates to a method for visualizing the positioning of a prosthesis as disclosed herein wherein i. the prosthesis is delivered by appropriate means close or relatively close to the target implantation site; ii. the prosthesis is approached to its final target site; iii. the movement of the prosthesis is stopped when the deformable indicator means indicate contact with the tissue of the final target site; and the prosthesis is fully deployed at its final target site.
  • the disclosure relates to a method for implantation of a heart valve prosthesis to a target site of an individual using a suitable catheter means and a heart valve prosthesis as described herein.
  • the prostheses as described herein may exhibit one or a number of advantages.
  • the prosthesis is designed to reduce the need for pacemaker implantation after aortic heart valve replacement therapy by increasing the distance from the stent scaffold to the bundle of His.
  • the corresponding need for pacemaker implantation may be less than 15%, such as less than 10% or even less than 8%.
  • the prosthesis may show little or no leakage, which may be unexpected for a non-symmetric design.
  • One advantageous feature may be that in the area of the NC either the proximal section is shortened vis-à-vis the RC and LC section or the proximal part of the NC may be characterized by an indentation in direction towards the inner area of the prosthesis.
  • locators may provide for a secure and/or precise positioning at the target site, e.g., in an advantageous manner such that they make sure that endogenous functions of the heart are satisfactory, like coronary artery function, bundle of His function, the valve as such with regard to functionality of the replacement valve, and the issue of leakage are met.
  • the design and functionality of the locators which may be, e.g., one, two, three or more locators, in the prosthesis and the foreshortening and the designed dimensions of the three sections of the prosthesis in relation to each other, the dimensions of the foreshortening as such and the dimensions of the proximal part of the prosthesis as well as the symmetry may contribute to various advantageous functional characteristics of the prosthesis as disclosed herein.
  • the attachment or design of the locators in an exemplary embodiment may be chosen to be in the middle area of the stent component.
  • the design of the locator e.g., as an arch, may provide for a foreshortening that may be advantageous in view of a precise and proper positioning of the prosthesis.
  • the indicator means may be positioned or connected with the medical device in a manner so that it may make contact with the appropriate body compartment(s) or body part(s) during the implantation procedure so as to indicate correct and precise positioning of the medical device. It may comprise or consist of one or more wires or antennas.
  • the disclosure includes an indicator means and a so called counterpart means wherein these two parts are designed to be capable to contact each other.
  • the prosthesis as described herein inter alia may be useful and may facilitate the correct positioning of a prosthesis at the target site and may avoid misplacement, e.g., based solely upon tactile feedback.
  • the prosthesis as disclosed comprises i. a shortened proximal section 17 or ii. it exhibits an indentation or open area in the proximal area of section 17, iii.
  • the distal sections 16, 18 have either an open area at the areas where they are contacting the coronary arteries or the stent in this area does not contain a covering, or the distal section has a length in these sections that does not extend in its final positioning at the target site towards the coronary arteries, iv. a non-symmetrical sealing means in design version i.), v. three locator means designed as arches connected at their ends with fastening arches, and vi. a foreshortening of 5mm.
  • Such an embodiment may be advantageous in terms of less interference with the endogenous heart function, may provide sufficient and/or good sealing features, and may be correctly positioned by way of minimally invasive catheter delivery.

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  • Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Cardiology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Transplantation (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Optics & Photonics (AREA)
  • Surgery (AREA)
  • Epidemiology (AREA)
  • Prostheses (AREA)

Claims (15)

  1. Prothèse de valvule cardiaque, pour traiter une insuffisance aortique, ladite prothèse comprenant un composant formant stent, un composant formant valvule, un moyen d'étanchement, et au moins un moyen de localisation pour un positionnement défini de la prothèse au niveau du site cible d'une valvule cardiaque endogène, et dans laquelle la prothèse est expansible depuis un état non expansé jusqu'à un état expansé, et dans laquelle, dans l'état expansé une distance la plus courte entre une extrémité proximale du moyen de localisation et une extrémité proximale de la prothèse est inférieure à 10 mm, en assurant ainsi une mise en place intra annulaire de la prothèse dans l'anneau aortique d'un coeur natif,
    dans laquelle le moyen de localisation est un arc de localisation qui est attaché ou qui fait partie intégrante, avec chacune de ses extrémités, d'un arc de fixation, ledit arc de fixation étant une partie du composant formant stent sur lequel est fixé le composant formant valvule.
  2. Prothèse selon la revendication 1,
    dans laquelle le moyen de localisation comprend une sonde de localisation pour la visualisation du moyen de localisation.
  3. Prothèse selon la revendication 1 ou 2,
    dans laquelle la distance entre une extrémité proximale du moyen de localisation et une extrémité proximale de la prothèse est variable en direction circonférentielle de la prothèse.
  4. Prothèse selon la revendication 1, 2 ou 3,
    dans laquelle, dans l'état non expansé le moyen de localisation et le composant formant stent s'étendent le long d'un périmètre du tube et, dans l'état expansé le moyen de localisation s'étend au moins partiellement à l'extérieur d'un périmètre du tube expansé.
  5. Prothèse selon la revendication 4,
    dans laquelle, dans l'état expansé le moyen de localisation est positionné en direction proximale au moins partiellement au-dessus de la portion restante du stent.
  6. Prothèse selon la revendication 5,
    dans laquelle le raccourcissement du moyen de localisation dans l'état expansé par comparaison à l'état non expansé est de 1, 2, 3, 4 ou 5 mm.
  7. Prothèse selon l'une quelconque des revendications précédentes,
    dans laquelle l'arc de fixation comprend des moyens de fixation.
  8. Prothèse selon l'une quelconque des revendications précédentes, conçue de manière à ne pas recouvrir sensiblement les artères coronaires dans l'état expansé lorsqu'elle est placée au niveau du site cible.
  9. Prothèse selon l'une quelconque des revendications précédentes, présentant trois sections, et dans laquelle une section correspond au sinus coronaire droit (RCS), une seconde section correspond au sinus coronaire gauche (LCS), et une troisième section correspond au sinus coronaire non coronaire (NCS).
  10. Prothèse selon la revendication 9,
    dans laquelle les trois sections comprennent chacune une extrémité distale et une extrémité proximale, et lesdites extrémités proximales s'étendent avec une longueur égale de telle façon que les sections RCS, LCS, NCS se terminent au même niveau, ou les extrémités proximales correspondant aux sections RCS et LCS sont plus courtes que la section NCS.
  11. Prothèse selon la revendication 10,
    dans laquelle les trois sections proximales s'étendent avec une longueur égale de telle façon que les sections RCS, NCS, NCS se terminent au même niveau et la section proximale NCS comprend un cran.
  12. Prothèse selon l'une quelconque des revendications précédentes, comprenant un moyen pour visualiser le positionnement de la prothèse au niveau d'un site cible d'un individu, dans laquelle le moyen comprend un moyen indicateur déformable.
  13. Prothèse selon la revendication 12,
    dans laquelle le moyen indicateur comprend ou est constitué d'un ou plusieurs fils ou antennes ; et/ou
    dans laquelle le moyen indicateur comprend un matériau radioopaque ; et/ou dans laquelle la prothèse comprend une contrepartie au moyen indicateur convenable pour venir en contact l'un avec l'autre, dans laquelle la contrepartie est de préférence un moyen de localisation, un palpeur, un dispositif de positionnement de cuspide, un crochet et/ou un rebord, et dans laquelle de préférence le moyen de localisation, le palpeur, le dispositif de positionnement de cuspide, le crochet et/ou le rebord a une forme en U, V, Y, M ou W ; et/ou
    dans laquelle le moyen indicateur et le moyen de localisation, le palpeur, le dispositif de positionnement de cuspide, le crochet et/ou le rebord comprennent le même matériau ou des matériaux différents, et dans laquelle la contrepartie comprend de préférence un matériau radioopaque.
  14. Prothèse selon l'une quelconque des revendications précédentes, constituée de ou comprenant du nitinol, un tissu souple, un textile, un tissu mammaire, un polymère, de préférence du silicone du polyuréthane ou du ePTFE.
  15. Prothèse selon l'une quelconque des revendications précédentes, dans laquelle la prothèse est une valvule cardiaque aortique.
EP16719802.7A 2015-05-01 2016-04-18 Dispositif à débit réduit de stimulateur cardiaque lors d'un remplacement de valvules cardiaques Active EP3288495B1 (fr)

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CN107530168B (zh) 2020-06-09
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US10709555B2 (en) 2020-07-14
US20180289471A1 (en) 2018-10-11
EP3632378B1 (fr) 2024-05-29
US20200390545A1 (en) 2020-12-17
EP3288495A1 (fr) 2018-03-07
JP2018516642A (ja) 2018-06-28
WO2016177562A1 (fr) 2016-11-10
EP3632378C0 (fr) 2024-05-29
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US11337800B2 (en) 2022-05-24
US20230139120A1 (en) 2023-05-04

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